Opioid Crisis Linked to Spike in Infective Endocarditis

— Ten-fold rise in one state prompts urgent call for action

Drug-associated infective endocarditis increased more than 10-fold from 2007 to 2017 in step with the opioid crisis in one state, researchers reported.

Annual hospitalizations related to the infection went from 0.92 to 10.95 per 100,000 persons during this time period in North Carolina. Admissions involving valve surgery also grew, from 0.10 to 1.38 per 100,000 persons per year.

In the last year of the study, people who used drugs accounted for 42% of all endocarditis valve surgeries performed in the state, according to a group led by Asher Schranz, MD, of the University of North Carolina in Chapel Hill, in a paper published online in Annals of Internal Medicine. The data had been previously presented at IDWeek in October.

The increase in drug-associated infective endocarditis is “largely attributable to opioids” and “aligns with the growing number of deaths from heroin and synthetic narcotic use in North Carolina, which began an acute upward trajectory in 2014,” the authors noted.

Given that each case of hospitalization and surgery for infective endocarditis costs more than $250,000, it is “almost certainly” cheaper to approach the problem with comprehensive outpatient treatment programs employing pharmacotherapy for opioid use, Schranz and colleagues said.

“A rational public health approach would prioritize funding of inpatient and outpatient drug use disorder treatment, harm reduction, and other activities to prevent infective endocarditis,” they argued.

Their study based on the North Carolina Hospital Discharge Database included 22,825 adults with a hospitalization for infective endocarditis, of which 11% could be tied to the patient’s drug use.